Abstract
A 10-year-old girl presented with esotropia. She had 35 prism diopters of esodeviation at far and near with left inferior oblique muscle overaction (+3). Cycloplegic refraction was +0.5D OD and +0.75D OS, and visual acuity was 20/25 in each eye. The patient was being treated with G-CSF (Leufokine?) due to her severe congenital neutropenia (WBC 3350, neutrophil 7.3%, and ANC 170/ul). Despite of low ANCs, we decided to perform a surgery because the patient and her parents strongly wanted it. Prophylactic topical antibiotics (Cravit?, levofloxacin 0.5%) were applied four times a day for three days prior to the surgery. We sterilized the periocular skin with povidone-iodine 10% and placed povidone-iodine 5% drops in the cul-de-sac preoperatively. Strabismus surgery was performed. After surgery, profuse irrigation with the entire bottle of topical antibiotics (Vigamox?, moxifloxacin hydrochloride 0.5%) was performed for each eye. We prescribed topical and highly potent systemic antibiotics for 1 week. This is the first case report to describe the successful perioperative antisepsis care following strabismus surgery for a patient with severe congenital neutropenia. Prevention of postoperative infection in granulocytopenic patients could be achieved using antibiotic agents which provide the greatest spectrum of coverage against both Gram-positive and Gram-negative infections.
Highlights
Periocular infections after strabismus surgery are rare but potentially serious
Severe congenital neutropenia is characterized by absolute neutrophil counts (ANCs) consistently below 200/ul, with recurrent, severe infections developing in the first months of life [4]
We describe a case of the successful perioperative care following strabismus surgery for a patient with severe congenital neutropenia
Summary
A 10-year-old girl presented with esotropia, which had been present since her first year of life, in September 2009. Upon examination, she had 35 prism diopters (PD) of esodeviation at far and near with left inferior oblique muscle overaction (IOOA) (+3) (Figure 1). The patient and her parents strongly insisted on the surgery, due to the emotional stress experienced by the patient on account of her esodeviated eyes. Authors determined to perform the surgery the family and the patient strongly insisted and her pediatrician allowed her the surgery on con-
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